Abstract
An increasing number of patients with metastatic colorectal cancer (mCRC) are able to receive 3 or more lines of therapy. Treatments in this setting can include regorafenib (an oral multikinase inhibitor), trifluridine/tipiracil hydrochloride (TAS-102), antibodies that target epidermal growth factor receptor for patients with RAS wild-type tumors (if no prior exposure), and, where approved, anti-programmed cell death protein 1 inhibitors for patients with microsatellite instability-high mCRC. Although guidelines describe the available treatment options, few insights are provided to guide selection and sequencing. In this article, we share expert opinion from diverse geographic regions, to offer guidance for best practice when selecting and managing third-line treatment for mCRC. Various factors, including performance status, age, and tumor sidedness, can be used to guide treatment selection. Biomarkers, such as RAS, BRAF, and microsatellite instability, can be useful for treatment stratification. Management of adverse events, to maintain quality of life, is a key consideration and is crucial to best practice in this setting. Common toxicities associated with third-line treatments are hand-foot skin reaction, fatigue, diarrhea, and cytopenias. Patients who receive third-line and later-line treatments should be monitored for these events, especially during the first 2 cycles. Dose modifications can also be used to manage toxicities and to minimize the effect on quality of life, while maximizing treatment benefit. Clinical trials of emerging agents, new treatment combinations, and novel therapies continue the efforts to improve outcomes for patients with mCRC. Sharing expert opinions on best practice for treatment selection and management can ultimately improve outcomes for patients with mCRC.
| Original language | English (US) |
|---|---|
| Journal | Clinical Colorectal Cancer |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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Keywords
- Patient selection
- Regorafenib
- TAS-102
- Treatment management
- Trifluridine/tipiracil
ASJC Scopus subject areas
- Oncology
- Gastroenterology
Cite this
Third- or Later-line Therapy for Metastatic Colorectal Cancer : Reviewing Best Practice. / Bekaii-Saab, Tanios; Kim, Richard; Kim, Tae Won; O'Connor, Juan Manuel; Strickler, John H.; Malka, David; Sartore-Bianchi, Andrea; Bi, Feng; Yamaguchi, Kensei; Yoshino, Takayuki; Prager, Gerald W.
In: Clinical Colorectal Cancer, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Third- or Later-line Therapy for Metastatic Colorectal Cancer
T2 - Reviewing Best Practice
AU - Bekaii-Saab, Tanios
AU - Kim, Richard
AU - Kim, Tae Won
AU - O'Connor, Juan Manuel
AU - Strickler, John H.
AU - Malka, David
AU - Sartore-Bianchi, Andrea
AU - Bi, Feng
AU - Yamaguchi, Kensei
AU - Yoshino, Takayuki
AU - Prager, Gerald W.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - An increasing number of patients with metastatic colorectal cancer (mCRC) are able to receive 3 or more lines of therapy. Treatments in this setting can include regorafenib (an oral multikinase inhibitor), trifluridine/tipiracil hydrochloride (TAS-102), antibodies that target epidermal growth factor receptor for patients with RAS wild-type tumors (if no prior exposure), and, where approved, anti-programmed cell death protein 1 inhibitors for patients with microsatellite instability-high mCRC. Although guidelines describe the available treatment options, few insights are provided to guide selection and sequencing. In this article, we share expert opinion from diverse geographic regions, to offer guidance for best practice when selecting and managing third-line treatment for mCRC. Various factors, including performance status, age, and tumor sidedness, can be used to guide treatment selection. Biomarkers, such as RAS, BRAF, and microsatellite instability, can be useful for treatment stratification. Management of adverse events, to maintain quality of life, is a key consideration and is crucial to best practice in this setting. Common toxicities associated with third-line treatments are hand-foot skin reaction, fatigue, diarrhea, and cytopenias. Patients who receive third-line and later-line treatments should be monitored for these events, especially during the first 2 cycles. Dose modifications can also be used to manage toxicities and to minimize the effect on quality of life, while maximizing treatment benefit. Clinical trials of emerging agents, new treatment combinations, and novel therapies continue the efforts to improve outcomes for patients with mCRC. Sharing expert opinions on best practice for treatment selection and management can ultimately improve outcomes for patients with mCRC.
AB - An increasing number of patients with metastatic colorectal cancer (mCRC) are able to receive 3 or more lines of therapy. Treatments in this setting can include regorafenib (an oral multikinase inhibitor), trifluridine/tipiracil hydrochloride (TAS-102), antibodies that target epidermal growth factor receptor for patients with RAS wild-type tumors (if no prior exposure), and, where approved, anti-programmed cell death protein 1 inhibitors for patients with microsatellite instability-high mCRC. Although guidelines describe the available treatment options, few insights are provided to guide selection and sequencing. In this article, we share expert opinion from diverse geographic regions, to offer guidance for best practice when selecting and managing third-line treatment for mCRC. Various factors, including performance status, age, and tumor sidedness, can be used to guide treatment selection. Biomarkers, such as RAS, BRAF, and microsatellite instability, can be useful for treatment stratification. Management of adverse events, to maintain quality of life, is a key consideration and is crucial to best practice in this setting. Common toxicities associated with third-line treatments are hand-foot skin reaction, fatigue, diarrhea, and cytopenias. Patients who receive third-line and later-line treatments should be monitored for these events, especially during the first 2 cycles. Dose modifications can also be used to manage toxicities and to minimize the effect on quality of life, while maximizing treatment benefit. Clinical trials of emerging agents, new treatment combinations, and novel therapies continue the efforts to improve outcomes for patients with mCRC. Sharing expert opinions on best practice for treatment selection and management can ultimately improve outcomes for patients with mCRC.
KW - Patient selection
KW - Regorafenib
KW - TAS-102
KW - Treatment management
KW - Trifluridine/tipiracil
UR - http://www.scopus.com/inward/record.url?scp=85059154364&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059154364&partnerID=8YFLogxK
U2 - 10.1016/j.clcc.2018.11.002
DO - 10.1016/j.clcc.2018.11.002
M3 - Article
C2 - 30598357
AN - SCOPUS:85059154364
JO - Clinical Colorectal Cancer
JF - Clinical Colorectal Cancer
SN - 1533-0028
ER -